STUDI E RICERCHE
Distance learning and the psychological state of nursing
students
Didattica a distanza e stato psicologico degli studenti infermieri
Gianluca Casaroli1 Stefano Finotto2
1 RN, Degree Course in
biotechnology, University of
Parma, Parco Area delle
Sciene, 11/a, 43124, Parma,
Italy. Tel: 3384756155; Email:
casaroli.gianluca@gmail.com
2 RN, M.Sc., Adjunt Professor
in Nursing Science, University
of Modena and Reggio
Emilia, Campus Universitario
“San Lazzaro”, Via Amendola
2 ­Padiglione De Sanctis,
42122 Reggio Emilia, Italy.
Phon. +39 0522 522001,
Email: sfinotto@unimore.it.
© 2023
Professioni Infermieristiche
Vol. 76 1 2023
RIASSUNTO
INTRODUZIONE: La sindrome respiratoria acuta grave Coronavirus-2 (SARS-CoV-2) e’ il nome dato al
coronavirus comparso in Cina, probabilmente nella citta’ di Wuhan, e rintracciato nell’uomo nel
dicembre 2019. La pandemia causata da questo nuovo virus ha portato ad uno stravolgimento della vita
delle persone in tutti gli ambiti: dalla scuola, alle attivita’ sportive, alle attivita’ lavorative, all’istruzione
e all’assistenza sanitaria.
L’istruzione è stata colpita in ogni forma e grado ed è stata costretta a mutare la tradizionale didat-
tica in presenza a favore di quella a distanza.
OBIETTIVO: Scopo dello studio è descrivere, attraverso la percezione degli studenti infermieri ita-
liani, l’efficacia della didattica a distanza e l’impatto di essa sullo stato psicofisico dello studente
durante il periodo di lockdown della prima ondata covid-19.
DISEGNO DI STUDIO: studio descrittivo analitico trasversale
METODI: Il campionamento è stato per convenienza. Esso è composto da 375 studenti iscritti al
Corso di Laurea in Infermieristica nell’anno accademico 2020-2021. Hanno aderito allo studio 239
studenti (64%). Lo strumento utilizzato per la raccolta dati è un questionario in formato elettronico.
RISULTATI: Gli studenti utilizzano maggiormente dispositivi mobili e la maggior parte di loro trova
di adeguata qualità l’audio in ingresso, il video in ingresso e la rete internet a disposizione. Gli osta-
coli vissuti principalmente dagli studenti sono: la mancanza di relazione con i compagni di corso
(32%), la mancanza della relazione con il docente (27%) e la mancanza di assistenza tecnica in caso
di problemi con le piattaforme utilizzate (19%). Emerge che la didattica a distanza fornisce meno
motivazione rispetto alla modalità in presenza. Il 74% degli studenti che ha risposto al questionario
crede che l’apprendimento online non abbia la stessa efficacia di quello in presenza. Il 38% degli
studenti ha ottenuto un punteggio di ansia media al GAD-7 e il 38% un punteggio di ansia minima
e in generale le emozioni negative sono state vissute dalla minoranza degli studenti.
CONCLUSIONI: la qualità dei dispositivi e della rete, la comunicazione con docenti e compagni
durante la didattica a distanza è stata valutata in modo sufficiente. La qualità dell’apprendimento
non ha riscontrato criticità troppo evidenti e la didattica a distanza non ha portato all’insorgenza di
condizioni di ansia grave e severa. Si può affermare quindi che la didattica a distanza non ha impat-
tato in modo negativo sullo stato psicologico e sull’apprendimento degli studenti infermieri e che
potrebbe rappresentare una valida integrazione alla didattica in presenza.
PAROLE CHIAVE: Sars-CoV2, studenti infermieri, Online Learning, Stress, emozioni, conoscenza
ABSTRACT
INTRODUCTION: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is the name
given to the coronavirus that appeared in China, probably in the city of Wuhan, and was traced in
humans in December 2019. The pandemic caused by this new virus has led to a disruption of peo-
ple's lives in all areas, schools, sports, work, education and healthcare.
Education has been affected at all levels and schools have found themselves obliged to replace tra-
ditional in-person learning with distance learning.
PURPOSE: The purpose of the study is to describe the effectiveness of distance learning and its
impact on the students’ physical and mental state during the lockdown of the first covid-19 wave,
through the eyes of Italian nursing students.
STUDY DESIGN: Descriptive analytical cross-sectional study.
METHODS: Sampling was by convenience. The sample comprised 375 students enrolled in the
Bachelor of Nursing programme in the academic year 2020-2021. A total of 239 students (64%)
participated in the study. The instrument used for data collection was a questionnaire in electronic
format.
RESULTS: Students use mobile devices to a greater extent and most of them find the audio / video
input and the internet connection to be of adequate quality.
The main obstacles experienced by the students were: lack of interaction with
fellow students (32%), lack of interaction with lecturers (27%), and the lack of technical assistance
in case of problems with the DL platforms used (19%). It has emerged that distance learning is less
motivational than in-person learning. 74% of the students who participated in the survey reported
that online learning was not as effective as in-person learning. 38% of the students scored medium
anxiety in the GAD-7 assessment and 38% scored minimal anxiety and, generally speaking, nega-
tive emotions were experienced by the minority of students.
CONCLUSIONS : the quality of the DL devices and the internet connection and interaction with
instructors and fellow students during distance learning was adequately assessed. Learning quality
was not overly affected by distance learning, which did not lead to the onset of serious and severe
anxiety conditions. It can therefore be stated that online/distance learning did not have a negative
impact on the psychological state and learning of the nursing students and can be viewed a valuable
support to in-person/classroom learning.
KEYWORDS: Sars-CoV2, Nursing Students, Online Learning,Stress, Emotion, Knowledge
46
47 Distance learning and the psychological state of nursing students

INTRODUCTION PURPOSE

Severe Acute Respiratory Syndrome Coronavirus-2 The purpose of the study is to describe the effectiveness
(SARS-CoV-2) is the name given to the coronavirus that of distance learning and its impact on the students’
appeared in China, probably in the city of Wuhan, and physical and mental condition during the lockdown of the
was detected in humans in December 2019. Coronaviruses first covid-19 wave, through the eyes of Italian nursing
are viruses that circulate among animals and can, in rare students. The specific aims of this research are to describe
cases, also infect human beings (Ministry of Health, the type and quality of the electronic devices used and the
2020). quality of the internet connection (1); to describe the
The pandemic caused by this new virus has led to a obstacles encountered in distance learning (2); to describe
disruption of people's lives in all areas, schools, sports, the quality of distance learning and the platforms used,
work, education and health care. compared to in-person classroom lectures, laboratory
Education has been affected at all levels and schools courses and examinations (3); to describe the emotions
have found themselves obliged to replace traditional in- experienced during the period of distance learning (4).
person learning with distance learning. According to
UNESCO (2020), the closing of schools due to the
pandemic has affected half the world's students, some 890 METHODS
million in 114 countries. In a very short time, we expe-
rienced a sudden shift from exclusively classroom learning Design
to exclusively distance learning. The design is a descriptive analytical cross-sectional
Distance education has been defined by Gaur et al. study.
(2020) and Klašnja-Milićević et al. (2017) as a method of
education that facilitates learning through the application Sample
of information and communication technology and Sampling was by convenience and comprised 375
provides students with the opportunity to access all students enrolled in the Bachelor of Science in Nursing
required educational programmes. Sejzi et al. (2012) have programme at the Reggio Emilia campus of the University
identified this mode of education as an alternative to the of Modena and Reggio Emilia (CDSIRE), in the 2020-
traditional view and consider the virtual classroom concept 2021 academic year. A total of 239 students (64%) took
as a viable prospect for both school and university educa- part in the study. The participating students were split
tion. according to the programme year, as follows: 108 in the
Distance learning has an impact on the emotional and first year, 77 in the second and 54 in the third.
psycho-somatic dimension of students, in fact, an analysis The socio-demographic breakdown of the sample is
of the relevant literature has brought to light a series diffe- shown in Table 1.
rent issues related to the emotional state of students.
Bahrambeygi et al. (2018), Kattoua & Al-Loz (2016) and Table 1: Socio-demographic data
Moore (2014) highlight how a feeling of isolation and loss N(%)
of personal contact between instructor and pupil can arise, AGE Average: 22 years ­ DS 4.84
threatening the educational interaction between the two MALE FEMALE
primary players in the educational process. Wang et al. GENDER 36 (15%) 203 (85%)
(2020) point out that the pandemic period was emotio- FIRST SECOND THIRD
nally stressful for the entire population, especially for the
YEAR 108 (45%) 77 (32%) 54 (23%)
most vulnerable groups; the study emphasises that one of
these is represented by university students, who are most at SINGLE SINGLE
OTHER
MALES FEMALES
risk of developing high levels of stress, anxiety and depres-
Married 7 (3%)
sion, particularly among female students. The analysis of MARRIAGE
84 (36%) 142 (59%) Engaged 3 (1%)
the work of Kopala-Sibley et al. (2016), Plexousakis et al. STATUS
Divorced 2 (1%)
(2019) and Schwartz et al. (2019) shows that some of the
IN THE
issues related to distance learning are represented by post- OUTSIDE THE CITY
CITY
traumatic stress disorder (PTSD) and depression. PLACE OF
125 (53%) 110 (47%)
Changes in teaching methodology have also occurred RESIDENCE
in Italian university settings. As a result of the SARS-CoV2 NO YES
pandemic, and in order to comply with the operational 193 (81%)
guidelines of the universities, based on the national and Father 151 (30%)
regional regulations, the nursing courses at universities DID YOU Mother 168 (34%)
SHARE THE Brother(s) 83 (17%)
have been required to reorganise their teaching methods,
HOUSE 46 (19%)
thereby changing the habits of both instructors and WITH Sister(s) 70 (14%)
students. These sudden changes can increase the risk of OTHERS? Friend(s) 8 (1%)
poor learning outcomes, with negative effects on the Boyfriend 14 (3%)
students' physical and mental health. Other relatives 10 (2%)

Professioni Infermieristiche
 Gianluca Casaroli, Stefano Finotto
Data Collection Tool
The tool used to collect data was a questionnaire
created on the basis of the analysed literature; the question-
naire was administered, in electronic form, through
Google Forms, the only requirement being owning a
personal account on the University of Modena and Reggio
Emilia (UNIMORE) platform. The questionnaire
featured validated instruments: the full Generalised
Anxiety Disorder Assessment (GAD-7) questionnaire
(Lowe B, Decker O, Muller S, et al., 2008), several items
of the Depression Anxiety Stress Scales Short Version
(DASS-21) questionnaire (Henry & Crawford, 2005), the
Kessler Psychological Distress Scale (K10) questionnaire
(Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer
JC, Hiripi E, et al 2003) and the Patient Health Question-
naire (PHQ-4) (Kroenke K, Spitzer RL, Williams JBW,
Löwe B., 2009).
The questionnaire comprised 56 statements/questions
concerning: socio-demographic data (7), the type and
quality of the electronic devices used (5), the obstacles
encountered during distance learning (1), the quality of
distance learning compared to in-person classroom
lectures, laboratory courses and examinations (26), and the
emotions experienced during distance learning (17). The
questionnaire consisted of either closed-type questions
with multiple choice answers or Likert scale questions.
Two types of Likert scales were used, one consisting of 4
items coded dichotomously (positive evaluations 1 –
Never, 2 – Some days and negative evaluations 3 – More
than half the days, 4 – Almost every day) and one consi-
sting of 5 items coded trichotomously (positive evaluations
4 – Agree, 5 – Strongly Agree, neutral evaluations 3 –
Neither Agree nor Disagree, and negative evaluations 1 –
Strongly Disagree, 2 – Disagree).
Face validity was calculated using the methodology
proposed by Sousa and Rojjanasrirat (2011) and was posi-
tive as all items scored above 80%. Content validity was
calculated using Cronbach's alpha which was found to be
0.64 for the entire questionnaire.
The questionnaire was administered electronically,
using Google Forms, in February 2021.
Data Analysis
A descriptive statistic of the data and frequency calcu-
lation was performed, Student's t-test between samples
with different variances and the Mann-Whitney test, assu-
ming p=0.05 for both tests as the level of significance level.
Ethics
The research protocol was approved by the Council of
the Nursing Degree Programme, based at the Reggio
Emilia campus of the University of Modena and Reggio
Emilia. The data collection guaranteed the anonymity of
the source and non-traceability of the data, thanks to the
settings in Google Forms, the e-mail addresses of the study
participants were not recorded.
The introduction to the questionnaire presented the
purpose of the study, the guarantee of anonymity of the
sources and the information according to which compiling
Vol. 76 1 2023
48
the questionnaire would be tantamount to acceptance of
the research study.
The data thus collected were used as a whole and not
individually and were processed in accordance with the
regulations in force in Italy (EEC Good Clinical Practice
(GCP), DM of 15 July 1997 and following
http://www.gazzettaufficiale.it/eli/id/1997/08/18/097A63
30/sg) and with the principles of the Declaration of
Helsinki. The rules of the relevant Ethics Committee were
complied with, even though no approval procedure was
required for this type of study.
RESULTS
With regard to the type and quality of the electronic
devices used in distance learning and the quality of the
internet connection, it emerged that (i) students tended to
use mobile devices the most (table 2), and that (ii) most of
them found the audio / video input and internet connec-
tion of adequate quality.
Table 2: Devices used by students in distance learning
DEVICE FREQUENCY PERCENTAGE
Desktop computers 29 8%
Laptop computers 220 64%
Tablets 27 8%
Smartphones 69 20%
Other 0 0%
The problems experienced by students, in connection
with distance learning, mainly consisted of the lack of inte-
raction with fellow students (32%), the lack of interaction
with instructors (27%), the poor IT skills of instructors
(42%), and the lack of technical assistance in case of
problems with the platforms used (19%).
With regard to the quality of distance learning
compared to classroom lectures, laboratory courses and
examinations, it emerged that 37% reported that the plat-
forms used did not facilitate interaction between all parti-
cipants. 33% of students found instructor/student interac-
tion easy and immediate during online lectures, and 54%
during online laboratory courses. In the online laboratory
courses, 39% of students found interaction between fellow
students easy, while 40% of students did not experience
this ease of interaction between fellow students during
online lectures.
It emerged that distance learning was less motivational
than in-person learning, but many students (59%) never-
theless found it easy to use and 68% of the sample reported
that distance learning allowed them to organise their
leisure time better.
74% of the students participating in the survey
reported that online learning is not as effective as in-person
learning and, although 45% of the students were neutral
about their overall assessment of distance learning, only
49
Chart 1: Satisfaction rating for Distance Learning
Chart 2: Negative emotions experienced by students in absolute numbers
Chart 3: Percentage frequency of perceived anxiety
Distance learning and the psychological state of nursing students
6% rated the experience as very satisfactory.
With regard to the emotional experience of the
students, it emerged that 38% of the students scored mild
anxiety on the GAD-7 and 38% scored minimal anxiety,
and, generally speaking, the negative emotions envisaged
in the questionnaire were experienced by a minority of
students. 60% of the students did not feel that the online
examinations decreased their anxiety. A statistically signifi-
cant difference (p=0.0178) emerged performing the
Mann-Whitney test, assuming 2 samples with different
variance, between students experiencing less anxiety
during online examinations and students experiencing the
same or greater anxiety, the latter noted greater concentra-
tion problems in following online lectures.
DISCUSSION
In the light of the results obtained, it can be stated that
the students surveyed in our sample mainly used mobile
devices, as in the study by Mohamed AbdEl-Hamed Diab
& FouadElgahsh (2020); furthermore, as in the results
obtained by Adnan (2020), most of the students also
enjoyed an adequate internet connection for distance lear-
ning. It can be inferred from the answers to the survey
questions that CDSIRE students are adequately equipped
and prepared for distance learning, probably because they
were already widely using the web resources provided by
the university before the pandemic.
The difficulties encountered in distance learning
mainly consist in the lack of technical support, in the case
of problems with the online platforms used and the lack of
interaction with both fellow students and instructors.
These results are in line with Wilcha's (2020) study, which
highlights, among the difficulties experienced by students,
technical problems (with the internet connection or the
hardware) and a sense of isolation and lack of social
exchange and meaningful interaction among the students.
Problems of a technical nature are probably linked to the
speed with which university facilities have had to adapt to
distance learning and the impossibility of coping with an
exponentially increasing demand for technical assistance.
Communication problems, which hinder relations with
instructors and fellow students, may also derive in part
from this fast-moving change, which has not allowed
students and instructors to adapt gradually to the transi-
tion and to learn how to make optimal use of the platforms
provided by the university.
The platforms themselves were found to be adequate
by the students, but the examinations were not without
technical problems and did not decrease anxiety compared
to in-person exams. The latter finding agrees with the
work of Savarese et al. (2020), who point out that for
many students, online exams are a huge source of stress,
especially if they held in the presence of other colleagues or
family members. Elsalem et al. (2020) confirms that most
students report being equally, or even more, stressed than
in the case of in-person exams. In our study, however, a
correlation emerges between increased exam anxiety and
Professioni Infermieristiche
 Gianluca Casaroli, Stefano Finotto
greater concentration problems during online classes.
Patricia Aguilera-Hermida (2020), argues that switching
to online systems is associated with decreased self-efficacy.
Although Hodges et al. (2020) point out that e-learning,
thanks in part to technological advances, facilitates the
delivery of theoretical content from instructors to learners,
our study shows that students perceive distance learning to
be less effective than classroom lectures. This negative
assessment is especially influenced by the difficulty of tran-
smitting practical competences and gestural skills during
the online laboratory courses. The students' negative
perception of distance learning as less motivating and less
effective is probably heightened by the poor computer
skills of some instructors, a fact that is emphasised by 42%
of the surveyed students. In the question concerning
overall satisfaction with DL, only a minority of students
found it to be unsatisfactory. This result, which evaluates
distance learning positively, deviates from the work of
Fawaz & Samaha (2021), where a majority of students
were dissatisfied, and is in agreement with the work of
Koirala et al. (2020), where a majority of students were
satisfied with the DL experience.
With regard to the physical and mental state of the
students, comparing the scores obtained from the GAD-7
assessment, the results differ from the work of Bolatov et
al. (2020); in fact, in the latter research, a majority of
students suffered from minimal anxiety, whereas in our
study minimal and mild anxiety are found to be equal. In
both studies, however, the minority of students expe-
rienced moderate and severe levels of anxiety and our
results show that negative emotions were either never expe-
rienced or were experienced only on a few occasions.
Students with a minimal anxiety score found distance
learning less effective, in terms of their clinical and theore-
tical preparation, but nevertheless believed that it allows
them to organise their leisure time better and they also find
the instructors to have sufficient IT skills to provide it. On
the other hand, those reporting a severe anxiety score
found distance learning less motivating, more tiring, less
user-friendly and limiting their ability to pursue meanin-
gful interactions.
CONCLUSIONS
According to the results of the survey, we can say that
students engaged in distance learning by using their
laptops to a greater extent and rated their internet connec-
tion quality as adequate and their audio / video input
quality as satisfactory, in agreement with the study by
Mohamed AbdEl-Hamed Diab & FouadElgahsh (2020).
The CDSIRE students had difficulty in adapting to the
new form of interaction during lectures and exams, but the
most critical issue concerned interaction between students
during lectures; these results are in line with Wilcha's
study (2020), which highlights, among the difficulties
experienced by students, problems of a technical nature
(with the internet connection or the hardware) and a
feeling of isolation and lack of physical interaction and
Vol. 76 1 2023
50
social exchange with the other students. With regard to the
overall assessment of distance learning, the majority of
students believes that online learning is not as effective as
classroom learning. This result, which was probably
influenced by the general condition of isolation required
by the pandemic that abruptly introduced online learning,
is not confirmed in the literature, which on the contrary
shows an improvement in online learning (Natarajian,
2006; Hodges et al., 2020). The majority of students also
provided a positive response to the survey questions for
assessing the overall distance learning experience. This
result is encouraging, compared to the study by Fawaz &
Samaha (2021), where a majority of students expressed
their dissatisfaction.
With regard to the emotions experienced in distance
learning, the majority of the survey participants reported
minimal and mild anxiety, with a low perception of nega-
tive emotions. This result is slightly worse than that of
Bolatov et al (2021).
In conclusion, it can be said that the quality of the
devices and of the connection and the level of interaction
with the instructors and fellow students in distance lear-
ning were adequately assessed. That the quality of learning
did not reveal any overly critical aspects and that distance
learning as a whole did not lead to the emergence of serious
and severe levels of anxiety, although – as a whole –
students consider online learning to be less effective than
in-person learning.
Distance learning did not have a negative impact on
the psychological condition and learning capacity of the
CDSIRE nursing students and could constitute a valuable
support to in-person learning.
LIMITATIONS OF THE STUDY
The main limitations of the study are related to the use
of a convenience sample and the fact that the sample was
taken only from the CDSIRE, which makes it difficult to
generalise the results.
Conflicts of interest: none. No external funding.
BIBLIOGRAPHY
Adnan, M. (2020). Online learning amid the COVID-19
pandemic: Students perspectives. Journal of Pedagogical
Sociology and Psychology, 1(2), 45–51.
https://doi.org/10.33902/JPSP.2020261309
Bahrambeygi F., Shojaeizadeh D., Sadeghi R., Nasiri S.
&Ghazanchaei E. (2018). The Effectiveness of an E-Learning
Program on Nurse’s Knowledge and Behavior for Caring of
Patients with Thromboembolism: A Comparative Study.
Journal of Nursing and Healthcare Management, 1(1), 1–7.
https://doi.org/10.18875/2639-7293.1.105
Barbour, M. K., Labonte, R., Kelly, K., Hodges, C., Moore, S.,
Lockee, B., Trust, T., & Bond, A. (2020). Understanding
Pandemic Pedagogy: Differences Between Emergency Remote,
Remote, and OnlineTeaching.https://doi.org/10.13140/RG.
2.2.31848.70401
51 Distance learning and the psychological state of nursing students
Bolatov, A. K., Seisembekov, T. Z., Askarova, A. Zh., Baikanova, R.
K., Smailova, D. S., & Fabbro, E. (2021). Online-Learning
due to COVID-19 Improved Mental Health Among Medical
Students. Medical Science Educator, 31(1), 183–192.
https://doi.org/10.1007/s40670-020-01165-y
Elsalem, L., Al-Azzam, N., Jum’ah, A. A., Obeidat, N., Sindiani, A.
M., &Kheirallah, K. A. (2020). Stress and behavioral changes
with remote E-exams during the Covid-19 pandemic: A cross-
sectional study among undergraduates of medical sciences.
Annals of Medicine and Surgery, 60, 271–279.
https://doi.org/10.1016/j.amsu.2020.10.058
Fawaz, M., & Samaha, A. (2021). E learning: Depression, anxiety,
and stress symptomatology among Lebanese university
students during COVID 19 quarantine. Nursing Forum,
56(1), 52–57. https://doi.org/10.1111/nuf.12521
Gaur, R., Mudgal, S. K., Dharni, I. T., Sharma, R., &Suyal, N.
(2020). Barriers encountered during online classes among
undergraduate nursing students during COVID-19 pandemic
in India. International Journal of Research in Medical
Sciences, 8(10), 3687. https://doi.org/10.18203/2320-
6012.ijrms20204252
Gaur, R., Mudgal, S. K., Kaur, S., & Sharma, R. (2020).
Undergraduate nursing students’ attitude towards online
classes during lockdown period in India: Imposed or
interested?. International Journal Of Community Medicine
And Public Health, 7(9), 3371.
https://doi.org/10.18203/2394-6040.ijcmph20203892
Hodges, C., Moore, S., Lockee, B., Trust, T., & Bond, A. (2020).
The Difference Between Emergency Remote Teaching and
Online Learning. Available: https://er.educause.edu/articles/
2020/3/the-difference-between-emergency-remote-teaching-
and-online-learning (20 March 2021)
Kattoua, T., & Al-Lozi, M. (2016). A Review of Literature on E-
Learning Systems in Higher Education. International Journal
of Business Management and Economic Research(IJBMER),
Vol 7(5),2016, 754-762.
Koirala, D., Silwal, M., Gurung, S., Bhattarai, M., & Kc, V. K.
(2020). Perception towards Online Classes during COVID-19
among Nursing Students of a Medical College of Kaski
District, Nepal. Journal of Biomedical Research &
Environmental Sciences, 1(6), 249–255.
https://doi.org/10.37871/jbres1151
Kopala-Sibley, D. C., Danzig, A. P., Kotov, R., Bromet, E. J.,
Carlson, G. A., Olino, T. M., Bhatia, V., Black, S. R., & Klein,
D. N. (2016). Negative emotionality and its facets moderate
the effects of exposure to Hurricane Sandy on children’s
postdisaster depression and anxiety symptoms. Journal of
Abnormal Psychology, 125(4), 471–481.
https://doi.org/10.1037/abn0000152
‫ﱬﱫ‬
Professioni Infermieristiche
Li, H. Y., Cao, H., Leung, D. Y. P., &Mak, Y. W. (2020). The
Psychological Impacts of a COVID-19 Outbreak on College
Students in China: A Longitudinal Study. International
Journal of Environmental Research and Public Health,
17(11), 3933. https://doi.org/10.3390/ijerph17113933
Mohamed Abd El-Hamed Diab, G., & Fouad Elgahsh, N. (2020).
E-learning During COVID-19 Pandemic: Obstacles Faced
Nursing Students and Its Effect on Their Attitudes While
Applying It. American Journal of Nursing Science, 9(4), 300.
https://doi.org/10.11648/j.ajns.20200904.33
Moore, R. L. (2014). Importance of Developing Community in
Distance Education Courses. TechTrends, 58(2),2024.
https://doi.org/10.1007/s11528-014-0733-x
Natarajan, M. (2006). Use of online technology for multimedia
education. Information Services & Use, 26(3), 249–256.
https://doi.org/10.3233/ISU-2006-26304
Patricia Aguilera-Hermida, A. (2020). College students’ use and
acceptance of emergency online learning due to COVID-19.
International Journal of Educational Research Open, 1,
100011. https://doi.org/10.1016/j.ijedro.2020.100011
Plexousakis, S. S., Kourkoutas, E., Giovazolias, T., Chatira, K., &
Nikolopoulos, D. (2019). School Bullying and Post-traumatic
Stress Disorder Symptoms: The Role of Parental Bonding.
Frontiers in Public Health, 7, 75.
https://doi.org/10.3389/fpubh.2019.00075
Schwartz, R. M., Rasul, R., Gargano, L. M., Lieberman Cribbin,
W., Brackbill, R. M., &Taioli, E. (2019). Examining
Associations Between Hurricane Sandy Exposure and
Posttraumatic Stress Disorder by Community of Residence.
Journal of Traumatic Stress, 32(5), 677–687.
https://doi.org/10.1002/jts.22445
Sejzi, A. A., Aris, B., & Yahya, N. (2012). The Phenomenon of
Virtual University in New Age: Trends and Changes. Procedia
- Social and Behavioral. Sciences, 56, 565–572.
https://doi.org/10.1016/j.sbspro.2012.09.689
UNESCO. (2020). COVID-19 educational disruption and
response.Available: https://en.unesco.org/themes/education-
emergencies/coronavirus-school-closures (20 march 2021)
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R.
C. (2020). Immediate Psychological Responses and Associated
Factors during the Initial Stage of the 2019 Coronavirus
Disease (COVID-19) Epidemic among the General
Population in China. International Journal of Environmental
Research and Public Health, 17(5), 1729.
https://doi.org/10.3390/ijerph17051729
Wilcha, R.-J. (2020). Effectiveness of Virtual Medical Teaching
During the COVID-19 Crisis: Systematic Review. JMIR
Medical Education, 6(2), e20963.
https://doi.org/10.2196/20963